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40 - Management of cancer in children

Published online by Cambridge University Press:  05 November 2015

Owen Tilsley
Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
Louise Hanna
Velindre Cancer Centre, Velindre Hospital, Cardiff
Tom Crosby
Velindre Cancer Centre, Velindre Hospital, Cardiff
Fergus Macbeth
Velindre Cancer Centre, Velindre Hospital, Cardiff
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This chapter aims to provide the reader with an introduction to the management of children with cancer. Contemporary reviews and resources will be referred to as appropriate. Radiotherapy is an important component of the treatment for many childhood tumours and this may involve advanced techniques including brachytherapy or protons, sometimes requiring referral to another centre or even abroad. Many different healthcare professionals are involved in the delivery of care, coordinated in the UK by specialised multidisciplinary teams (MDTs) at one of 19 principal treatment centres, often in collaboration with shared care units closer to home.

Paediatric cancer is uncommon. Of the 280,000 patients diagnosed with cancer in England in 2012, only 1303 were children (0.5%). The incidence of some childhood cancers has increased marginally over the last 40 years, but death rates have declined dramatically for all non-CNS childhood cancers. With cure rates now over 70%, the prevalence of paediatric cancer survivors in the population is increasing rapidly, posing challenges for the management of cancer survivorship and the late effects of treatment. The incidence of cancer between the ages of 10 and 65 is well modelled by a 10% increase per annum, which equates to a 10-fold increase every 25 years. Given the relative rarity of paediatric cancer, it is still unusual to encounter an adult survivor of paediatric malignancy, but will become more common.

An important challenge in treatment is to minimise toxicity while maximising the chance of cure, leading to a risk-based stratification of treatment intensity, including for radiotherapy. As a result, most paediatric cancer is delivered using nationally or internationally agreed protocols. Radiotherapy has significant late toxicity as it reduces the natural growth seen in childhood, and, because of the long life expectancy of survivors, it may cause radiotherapy-induced second malignancies.

The radiotherapy pathway

Giving radiotherapy to children is complex and requires a team of clinical oncologists, therapeutic radiographers, mould room staff and play specialists, together with nurses, anaesthetic staff, physicists, dosimetrists, and psychologists or psychotherapists.

Play therapy

Play therapy is important in preparing children for radiotherapy. If the trust and cooperation of a younger child can be gained, treatment may not require a general anaesthetic.

Publisher: Cambridge University Press
Print publication year: 2015

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Calaminus, G., Kortmann, R., Worch, J., et al. (2013). SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease. Neuro. Oncol. 15, 788–796.CrossRefGoogle ScholarPubMed
Cohen, K. J., Pollack, I. F., Zhou, T., et al. (2011). Temozolomide in the treatment of high-grade gliomas in children: a report from the Children's Oncology Group. Neuro. Oncol., 13, 317–323.Google ScholarPubMed
Friedman, D. L., Whitton, J., Leisenring, W., et al. (2010). Subsequent neoplasms in 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J. Natl Cancer Inst., 102, 1083–1095.CrossRefGoogle ScholarPubMed
Fulton, D. S., Urtasun, R. C., Scott-Brown, I., et al. (1992). Increasing radiation dose intensity using hyperfractionation in patients with malignant glioma. J. Neurooncol., 14, 63–72.CrossRefGoogle ScholarPubMed
Gajjar, A., Chintagumpala, M., Ashley, D., et al. (2006). Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma (St Jude Medulloblastoma-96): long-term results from a prospective, multicentre trial. Lancet Oncol., 7, 813–820.CrossRefGoogle ScholarPubMed
Lannering, B., Rutkowski, S., Doz, F., et al. (2012). Hyperfractionated versus conventional radiotherapy followed by chemotherapy in standard-risk medulloblastoma: results from the randomized multicenter HIT-SIOP PNET 4 trial. J. Clin. Oncol., 30, 3187–3193.CrossRefGoogle ScholarPubMed
MacDonald, T. J., Aguilera, D. and Kramm, C. M. (2011). Treatment of high-grade glioma in children and adolescents. Neuro. Oncol., 13, 1049–1058.CrossRefGoogle ScholarPubMed
Mann, J. R., Raafat, F., Robinson, K., et al. (2000). The United Kingdom Childrens Cancer Study Groups second germ cell tumor study: carboplatin, etoposide, and bleomycin are effective treatment for children with malignant extracranial germ cell tumors, with acceptable toxicity. J. Clin. Oncol., 18, 3809–3818.CrossRefGoogle Scholar
Mead, G. (2007). The effects of cancer treatment on reproductive functions. Clin. Med., 7, 544–545.CrossRefGoogle ScholarPubMed
Mitchell, C., Pritchard-Jones, K. and Shannon, R. (2006). Immediate nephrectomy versus preoperative chemotherapy in the management of non-metastatic Wilms’ tumour: results of a randomised trial (UKW3) by the UK Children's Cancer Study Group. Eur. J. Cancer, 42, 2554–2562.CrossRefGoogle ScholarPubMed
Mueller, S. and Chang, S. (2009). Pediatric brain tumors: current treatment strategies and future therapeutic approaches. Neurotherapeutics, 6, 570–586.CrossRefGoogle ScholarPubMed
Reulen, R. C, Winter, D. L., Frobisher, C., et al. (2010). Long-term cause-specific mortality among survivors of childhood cancer. J. Am. Med. Ass., 304, 172–179.CrossRefGoogle ScholarPubMed
Ris, M. D., Packer, R. and Goldwein, J. (2001). Intellectual outcome after reduced-dose radiation therapy plus adjuvant chemotherapy for medulloblastoma: a Childrens Cancer Group study. J. Clin. Oncol., 19, 3470–3476.CrossRefGoogle Scholar
Rubnitz, J. E. (2012). How I treat pediatric acute myeloid leukemia. Blood, 119, 5980–5988.CrossRefGoogle Scholar
SIGN. (2013). SIGN 132. Long Term Follow up of Survivors of Childhood Cancer.Edinburgh: Scottish Intercollegiate Guidelines Network.
Shimada, H., Ambros, I. M., Dehner, L. P., et al. (1999). The International Neuroblastoma Pathology Classification (the Shimida system). Cancer, 86, 364–372.3.0.CO;2-7>CrossRefGoogle Scholar
Spostol, R., Ertel, I. E., Jenkin, R. D., et al. (1989). The effectiveness of chemotherapy for treatment of high grade astrocytoma in children: results of a randomized trial. J. Neurooncol., 7, 165–177.CrossRefGoogle Scholar
Spoudeas, H. A. (2005). Paediatric Endocrine Tumours.Crawley, West Sussex: Novo Nordisk Ltd. Available at:, accessed January 2015.Google Scholar
Stupp, R., Hegi, M. E., Mason, W. P., et al. (2009). Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol., 10, 459–466.CrossRefGoogle Scholar
Taylor, R. E., Bailey, C. C., Robinson, K., et al. (2003). Results of a randomized study of preradiation chemotherapy versus radiotherapy alone for nonmetastatic medulloblastoma: The International Society of Paediatric Oncology/United Kingdom Childrens Cancer Study Group PNET-3 Study. J. Clin. Oncol., 21, 1581–1891.CrossRefGoogle Scholar

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